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01.11.2014 | Pediatric Original

Evolution of inspiratory diaphragm activity in children over the course of the PICU stay

verfasst von: Guillaume Emeriaud, Alexandrine Larouche, Laurence Ducharme-Crevier, Erika Massicotte, Olivier Fléchelles, Amélie-Ann Pellerin-Leblanc, Sylvain Morneau, Jennifer Beck, Philippe Jouvet

Erschienen in: Intensive Care Medicine | Ausgabe 11/2014

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Abstract

Purpose

Diaphragm function should be monitored in critically ill patients, as full ventilatory support rapidly induces diaphragm atrophy. Monitoring the electrical activity of the diaphragm (EAdi) may help assess the level of diaphragm activity, but such monitoring results are difficult to interpret because reference values are lacking. The aim of this study was to describe EAdi values in critically ill children during a stay in the pediatric intensive care unit (PICU), from the acute to recovery phases, and to assess the impact of ventilatory support on EAdi.

Methods

This was a prospective longitudinal observational study of children requiring mechanical ventilation for ≥24 h. EAdi was recorded using a validated method in the acute phase, before extubation, after extubation, and before PICU discharge.

Results

Fifty-five critically ill children were enrolled in the study. Median maximum inspiratory EAdi (EAdi_max) during mechanical ventilation was 3.6 [interquartile range (IQR) 1.2–7.6] μV in the acute phase and 4.8 (IQR 2.0–10.7) μV in the pre-extubation phase. Periods of diaphragm inactivity (with no detectable inspiratory EAdi) were frequent during conventional ventilation, even with a low level of support. EAdi_max in spontaneous ventilation was 15.4 (IQR 7.4–20.7) μV shortly after extubation and 12.6 (IQR 8.1–21.3) μV before PICU discharge. The difference in EAdi_max between mechanical ventilation and post-extubation periods was significant (p < 0.001). Patients intubated mainly because of a lung pathology exhibited higher EAdi (p < 0.01), with a similar temporal increase.

Conclusions

This is the first systematic description of EAdi evolution in children during their stay in the PICU. In our patient cohort, diaphragm activity was frequently low in conventional ventilation, suggesting that overassistance or oversedation is common in clinical practice. EAdi monitoring appears to be a helpful tool to detect such situations.

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Titel: Evolution of inspiratory diaphragm activity in children over the course of the PICU stay
verfasst von: Guillaume Emeriaud
Alexandrine Larouche
Laurence Ducharme-Crevier
Erika Massicotte
Olivier Fléchelles
Amélie-Ann Pellerin-Leblanc
Sylvain Morneau
Jennifer Beck
Philippe Jouvet
Publikationsdatum: 01.11.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 11/2014
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-014-3431-4

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Evolution of inspiratory diaphragm activity in children over the course of the PICU stay